Dental Appeals Sr. Claims Examiner,

Alternate Locations: Charlotte, NC (North Carolina); Dover, NH (New Hampshire); Greensboro, NC (North Carolina); Omaha, NE (Nebraska); Work from Home

 

 Work Arrangement:

Remote : Work at home employee residing outside of a commutable distance to an office location.

 

Relocation assistance:  is not available for this opportunity.

 

Requisition #: 76033

 

The Role at a Glance

This position is responsible for the review of Dental appeals by providing an independent review of the facts and circumstances, within the state and federal regulations including ERISA/DOL.  In this role, you will act on new dental appeals within 5 business days, and render appeal decisions within 15 days for pre-service, and 30 days for post-service. Written communication of appeal upholds will be clear and concise, and site decision rationale in clear, easy to understand terms.  You will partner with other departments, such as Enrollments and DentalConnect as needed, while adhering to PHI.  Read on!

What you'll be doing

• You will analyze & process claims by investigating information. Apply claim policies & procedures and engages intervention of internal/external resources to ensure fair, ethical, & timely management of assigned claims.
• You will analyze and interpret complex coverage contracts to determine if eligibility is met.
• You will liaise with various stakeholders from across the business (Enrollments, DentalConnect) to obtain needed information to clarify and address issues.
• You will rovide customers with explanations of policy details and claim determination.
• You will effectively utilize and implement policies & procedures regarding overall claims workflow. 
• You will propose and develop practices & processes to improve performance and the customer experience.
• You will work as an individual and part of a team to ensure all new appeal assignments are acted on within department turnaround times.

What we’re looking for

 

Must have:

• High School diploma or GED or minimum Associate degree in lieu of required experience. (Minimum Required)
• 3 - 5+ Years of claims processing experience directly aligned to the specific responsibilities for this role. (Required)

 

Nice to haves:.

• 3-5 years experience processing dental claims.  
• Understand dental medical terms, records and test results.
• Ability to read, analyze and interpret Dental policies.
• Demonstrate strong written and verbal communication.
• Ability to work with others in a team environment.
• Demonstrates excellent organizational skills with the ability to prioritize workload and multi-task while maintaining strict attention to detail.
• Demonstrates strong interpersonal skills with a collaborative style.
• Demonstrates the ability to use sound judgment and discretion regarding confidential information

Application Deadline

 

What’s it like to work here?

At Lincoln Financial, we love what we do. We make meaningful contributions each and every day to empower our customers to take charge of their lives. Working alongside dedicated and talented colleagues, we build fulfilling careers and stronger communities through a company that values our unique perspectives, insights and contributions and invests in programs that empower each of us to take charge of our own future. 

 

What’s in it for you:

• Clearly defined career tracks and job levels, along with associated behaviors for each of Lincoln's core values and leadership attributes

• Leadership development and virtual training opportunities

• PTO/parental leave

• Competitive 401K and employee benefits

• Free financial counseling, health coaching and employee assistance program

• Tuition assistance program

• Work arrangements that work for you

• Effective productivity/technology tools and training

 

The pay range for this position is $25.87 - $30.34 with anticipated pay for new hires between the minimum and midpoint of the range and could vary above and below the listed range as permitted by applicable law. Pay is based on non-discriminatory factors including but not limited to work experience, education, location, licensure requirements, proficiency and qualifications required for the role. The base pay is just one component of Lincoln’s total reward